Advanced Dental Professionals, LLC

NPI #1306359450 in Wausau, Wisconsin

Provider Information

NPI Number: 1306359450
Entity Type: Organization
Organization Name: Advanced Dental Professionals, LLC
Primary Specialty: Dentist
Enumeration Date: Nov 13, 2017
Last Updated: Nov 13, 2017

Practice Location

Address: 617 JACKSON ST
City: Wausau
State: Wisconsin
ZIP Code: 54403-5550
Phone: (715) 842-0765

Authorized Official

Name: OLGA GRENOVA
Title: DIRECTOR OF ACCOUNTING
Phone: (608) 833-2213

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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